Activities-Specific Balance Confidence (ABC) Scale Use as an - PowerPoint PPT Presentation

Activities-Specific Balance Confidence (ABC) Scale Use as an outcome measure post-stroke Lindsey N. Jones, SPT Virginia Commonwealth University

What is the ABC? ¤ Self-report (subjective) measure of a patient’s level of confidence in performing various activities without losing balance or becoming unsteady ( balance self-efficacy ) ¤ Self-administered or administered via interview ¤ 16 items: various ambulatory activities, e.g., walking around house, reaching for objects, éê stairs, walking in a crowded mall, step onto or off an escalator, walk on icy sidewalks ¤ Wider continuum of item difficulty than Falls Efficacy Scale (FES) à more suitable for moderate to high functioning adults

Scoring the ABC ¤ 11-point scale, ranging from 0-100% for each of 16 items ¤ Score of 0 = no confidence, score of 100 = complete confidence ¤ Sum individual item scores, then divide total by 1600 to yield the mean ABC Scale score (range 0-100%)

Interpreting ABC Scores ¤ 80% = high level of physical functioning ¤ 50-80% = moderate level of physical functioning ¤ <50% = low level of physical functioning (Myers, 1998) ¤ <67% = older adults at risk for falling; predictive of future fall (LaJoie, 2004) - **no cut-off score has been established for the stroke population ¤ Normative data for individual item and total ABC scores is available for patients with stroke (Botner, Miller, & Eng, 2005)

ABC Details ¤ Time to Administer: 10-20 minutes ¤ Age Range: 18-64, 65+ ¤ Diagnoses to Use ABC with: Stroke ¤ MS ¤ Parkinson’s Disease ¤ Vestibular disorders ¤ TBI ¤ Lower limb amputations ¤ ¤ No training required ¤ Cost: FREE

Psychometrics of the ABC ¤ Good test-retest reliability: ICC = 0.85 (95% CI 0.68-0.93) ¤ Standard Error of Measurement (SEM) = 6.81 ¤ Strong internal consistency: Chronbach’s α = 0.94 ¤ Validity: significant correlations with Berg and gait speed; however, not particularly strong correlation coefficients (0.36 and 0.48 respectively) Botner, E., Miller, W., & Eng, J. (2005). Measurement properties of the Activities-specific Balance Confidence Scale among individuals with stroke. Disability & Rehabilitation, 27 (4): 156-163. doi: 10.1080/09638280400008982

Balance Self-Efficacy: Relevance as an Outcome of Stroke Rehab THE EVIDENCE

Community Participation Following Stroke ¤ 39-65% of community-dwelling people with stroke reported activity limitations and participation restrictions à low level of satisfaction with community integration (Pang, Eng, & Miller, 2007) ¤ Loss of independent community ambulation à poor quality of life, decreased satisfaction, mood disorders ¤ Ability “to get out and about” very important to ~75% of stroke patients (Durcan et al., 2015) ¤ Believed that an individual’s willingness to engage in a certain behavior is influenced by his/her perception that he/ she will be able to safely complete the behavior (Kuys, Donovan, Mattin, & Choy, 2015)

Factors associated with community ambulation in chronic stroke Durcan, Flavin, & Horgan, 2015 ¤ Participants: 40 community-dwelling stroke patients between 1- & 3-years post-stroke; >18 yo ¤ 10 MWT (gait speed), TUG, and ABC Scale significantly associated with community ambulation ¤ Balance self-efficacy (as measured by ABC Scale) was the only factor independently associated with community ambulation post-stroke ¤ May be a stronger predictor of return to independent community ambulation than physical factors such as gait speed and balance

Balance self-efficacy & its relevance to physical function & perceived health status after stroke Salbach, et al., 2006 ¤ Participants: 91 patients with stroke, discharged from rehab therapy with residual walking deficit ¤ Balance self-efficacy unrelated to age, stroke characteristics, or number of comorbidities; is related to sex, level of depressive symptoms, & physical functioning ¤ Balance self-efficacy (as measured by ABC Scale) was a significant predictor of physical function & physical health , as well as perceived health status ¤ “Enhancing balance self-efficacy in addition to functional walking capacity is expected to enhance physical function and perceived health status to a greater extent than enhancing functional walking capacity alone.”

Determinants of satisfaction with community reintegration in older adults with chronic stroke Pang, Eng, & Miller, 2007 ¤ Participants: 63 community-dwelling older adults (>50 yo) with chronic stroke (onset ≥ 1 yr) ¤ ABC Scale scores independently associated with Reintegration to Normal Living (RNL) Index scores ¤ Comparable to contributions from actual balance ability ¤ Walking endurance (6 MWT) NOT significantly associated with community reintegration ¤ Despite ability to walk independently, 89% of patients were not satisfied with level of community reintegration

Fall-related self-efficacy, not balance & mobility performance, is related to accidental falls in chronic stroke survivors with low BMD Pang & Eng, 2007 ¤ Participants: 39 chronic stroke survivors with low hip BMD (T-score ≤ 1.0) ¤ Fall-related self-efficacy, but NOT balance/mobility performance, is independently associated with falls in chronic stroke patients with low hip BMD ¤ Those with higher ABC scores (>80) are significantly less likely to fall than those with lower scores ( ≤ 80) ¤ BERG score or gait speed alone unable to explain falls in community-dwelling older adults with chronic stroke

Concordance & discordance between measured & perceived balance & the effect on gait speed & falls following stroke Liphart, et al., 2015 ¤ ~1/3 of patients demonstrate discordance between balance perception and balance performance in the first year post-stroke ¤ Perceived balance impacts gait speed, but not fall incidence ¤ Higher perception of balance à faster gait speed ¤ Falls more closely associated with measured balance than perceived balance

Summary of the Evidence ¤ Studies have their limitations, and some of the evidence is a little contradictory ¤ HOWEVER, overall they show that balance self-efficacy may be as important as actual balance and walking function in patients post-stroke ¤ ABC Scale may be important adjunct outcome measure to physical function measures like the BERG, 6 MWT, TUG, and 10 m walk test

Implications ¤ ê ABC Scale scores may represent major psychological barrier à self-imposed activity limitations and participation restrictions à deconditioning, deterioration of balance & mobility function à FALLS or ê quality of life ¤ Use ABC as outcome measure to identify those with decreased balance self-efficacy & at increased risk for falls

Ways to Improve ABC Scores ¤ Positive experiences performing a given task, including mastery experience, vicarious experience, and verbal persuasion ¤ Ex: group exercise programs including resistance training, agility training, weight-shifting exercises, tai chi, & task-oriented training (Pang, et al., 2007) ¤ Cognitive-behavioral programs, with group discussion, mutual problem solving, exercise training, & assertiveness training (Pang & Eng, 2007) ¤ Group exercise programs (Pang & Eng, 2007) ¤ More research needed on interventions to improve ABC Scale scores/balance self-efficacy

Questions?

References Botner, E., Miller, W., & Eng, J. (2005). Measurement properties of the Activities- ¤ specific Balance Confidence Scale among individuals with stroke. Disability & Rehabilitation, 27 (4): 156-163. doi:10.1080/09638280400008982 Durcan, S., Flavin, E., & Horgan, F. (2015). Factors associated with community ¤ ambulation in chronic stroke. Disability and Rehabilitation,Early Online , 1-5. doi:DOI: 10.3109/09638288.2015.1035460 Kuys, S., Donovan, J., Mattin, S., & Choy, N. (2015). Balance self-efficacy in older ¤ adults following inpatient rehabilitation. International Journal of Rehabilitation Research, 38 , 167-172. doi:10.1097/MRR.0000000000000106 Liphart, J., Gallichio, J., Tilson, J., Pei, Q., Wu, S., & Duncan, P. (2015). Concordance ¤ and discordance between measured and perceived balance and the effect on gait speed and falls following stroke. Clinical Rehabilitation, 1-7. doi:10.1177/0269215515578294

References (cont’d.) Pang, M., Eng, J., & Miller, W. (2007). Determinants of Satisfaction With Community ¤ Reintegration in Older Adults With Chronic Stroke: Role of Balance Self- Efficacy. Physical Therapy, 87 , 282-291. doi:10.2522/ptj.20060142 Pang, M., & Eng, J. (2007). Fall-related self-efficacy, not balance and mobility ¤ performance, is related to accidental falls in chronic stroke survivors with low bone mineral density. Osteoporosis International, 19 , 919-927. doi: 10.1007/s00198-007-0519-5 Raad, J. (n.d.). Rehab Measures - Activities-Specific Balance Confidence Scale. ¤ Retrieved June 24, 2015, from http://www.rehabmeasures.org/Lists/ RehabMeasures/DispForm.aspx?ID=949 Salbach, N., Mayo, N., Robichaud-Ekstrand, S., Hanley, J., Richards, C., & Wood- ¤ Dauphinee, S. (2006). Balance Self-Efficacy and Its Relevance to Physical Function and Perceived Health Status After Stroke. Archives of Physical Medicine and Rehabilitation, 87 , 364-370. doi:10.1016/j.apmr.2005.11.017